Proclemer A, Gianfagna P, Fontanelli A, Bernardi G, Feruglio G A
Istituto di Cardiologia, Ospedale Civile di Udine.
G Ital Cardiol. 1987 May;17(5):402-13.
Recurrent, sudden temporary loss of consciousness is a common clinical problem: in the absence of electrocardiographic monitoring during a syncopal episode (S), abnormalities demonstrated by an electrophysiological study (ES) may suggest the etiology of S. We have performed a complete ES in 53 Pts (M. 38-F. 15, mean age 63 y.) with recurrent unexplained S (3.8 S/pt) by means of a standardized protocol. Group I: 30 Pts (mean age 65 y, 3.6 S/pt) with structural heart disease. Thirteen of these had abnormal ES findings: inducible ventricular tachycardia in 6, prolonged HV interval in 7 (with bundle branch block), very fast atrial flutter in one. Group II: 23 Pts (mean age 61 y., 3, 9 S/pt), without organic heart disease. The ES was abnormal in 14 Pts showing a prolonged HV interval in 11 (with bundle branch block), an intrahisian block in 1 and an inducible AV nodal tachycardia with heart rate greater than 200/m' in one. Only the Pts with abnormal ES were treated according to their condition with amiodarone or with an implantable pacemaker. Three PTs with C.H.D. and normal ES successfully underwent by-pass surgery. During the follow-up (20 months) therapy based on ES provided symptomatic relief (no S) in 25 of 26 Pts with abnormal electrophysiological study. Syncope persisted in 4 of 26 Pts in whom ES did not define a mechanism of S. No sudden death in any Pt.
ES was, therefore, of diagnostic value in more than half of the patients with syncope of unknown cause and long-term treatment based on ES was successful in the prevention of S (remission rate of 93% in patients treated with amiodarone or pacemaker).
反复出现的突发性短暂意识丧失是一个常见的临床问题：在晕厥发作（S）期间缺乏心电图监测的情况下，电生理研究（ES）所显示的异常可能提示晕厥的病因。我们通过标准化方案对53例（男性38例，女性15例，平均年龄63岁）不明原因反复晕厥（每位患者晕厥3.8次）的患者进行了完整的电生理研究。第一组：30例患者（平均年龄65岁，每位患者晕厥3.6次）患有结构性心脏病。其中13例电生理研究结果异常：6例可诱发室性心动过速，7例HV间期延长（伴有束支传导阻滞），1例为非常快速的心房扑动。第二组：23例患者（平均年龄61岁，每位患者晕厥3.9次），无器质性心脏病。14例患者电生理研究异常，其中11例HV间期延长（伴有束支传导阻滞），1例希氏束内阻滞，1例可诱发房室结性心动过速且心率大于200次/分钟。只有电生理研究异常的患者根据病情接受了胺碘酮治疗或植入了起搏器。3例患有冠心病且电生理研究正常的患者成功接受了搭桥手术。在随访（20个月）期间，基于电生理研究的治疗使26例电生理研究异常的患者中的25例症状缓解（无晕厥）。26例电生理研究未明确晕厥机制的患者中有4例仍有晕厥。所有患者均未发生猝死。
因此，电生理研究对超过一半原因不明的晕厥患者具有诊断价值，基于电生理研究的长期治疗成功预防了晕厥（接受胺碘酮或起搏器治疗的患者缓解率为93%）。
